Minding the Guarantee Gap: Navigating the Fine Print of a PBM Offer

Presenters: Justine Wiebusch, Vice President Health Plan Consulting, Steve Baumgardner, VP & Practice Leader, Health Plan Consulting

This event has ended. The slides are published here, and the recorded session is accessible here.

Navigating Pharmacy Benefit Manager (PBM) contract guarantees to improve pricing can be challenging for health plans. PBMs will commonly exclude certain guarantees in their contracts, such as for products deemed difficult to forecast for discount and rebate purposes. Alternately, some PBMs will exclude products that appear to improve discount and rebate guarantees on paper without actually improving overall pricing.

The Burchfield Group’s expert team can help health plans quantify future drug spend that may currently be excluded from PBM rebate or discount guarantees. Although it is estimated that 2020 contracts only have 5-8% of spend not subject to guarantees, industry trends suggest this could increase to 10%-20%+ of drug spend. Therefore, benchmarking PBM guarantee exclusions gives health plans clearer insight into the true total value of a PBM’s financial package – providing greater transparency and negotiating leverage.

In this webinar, you will:    

  • Learn common PBM contract exclusions for rebates and discounts

  • Understand current and emerging industry trends that are increasing drug spend within drug categories commonly excluded from PBM guarantees

  • Preview updates to The Burchfield Group’s Request for Proposal (RFP) process for health plans designed to improve transparency into drug spend not subject to guarantees.